Dispatches from the 10th Crusade

What’s Wrong with the World
is dedicated to the defense of
what remains of Christendom, the civilization made by the men of
the Cross of Christ. Athwart two hostile Powers we stand: the
Jihad and Liberalism...read more

A case for throwing patients out in the streets

Occasionally when discussing horrors like this (the recent news of dehydration of infants and children in the current UK medical system), one will run into a liberal troll, who supports both the dehydration killings and a socialized medical system, who confidently pronounces, "If these people want their children to be kept alive, they are certainly free to pay extra for it and go to a private hospital instead."

Really?

There are many, many things wrong with this response, but as surely as God made little green apples, you will run into it somewhere, some time, if you point out the evil of these killings.

The first and easiest thing to point out that is wrong with this response is that it is probably factually false. Aside from the fact that private institutions may be prohibitively expensive, what evidence does the chipper leftist actually have that patients are not dehydrated to death in private hospitals? As far as I know, no evidence at all. The assertion is simply made. Considering the fact that hospitals all over America have been dehydrating patients to death for quite some time in a non-socialized system (even before Obamacare came along), the prospects for this assertion aren't terribly good. The bald statement that if only these folks would pony up they could get their relatives fed seems merely to make the liberal feel that he has racked up debating points, especially as it's allegedly some sort of "score" against a pro-life opponent who also thinks socialized medicine a bad idea. It does not appear to be based on evidence.

I think we can say with a great deal of confidence that the families of patients in the NHS are not being told, "Hey, for an extra twenty thousand Euros or so, we'll keep feeding your child/parent/spouse." In fact, that would, I think we can guess, be regarded as bribery and corruption (and would be so regarded with some plausibility). So the statement, "If they'd pay for it, they could avoid this outcome" is not only shockingly bad ethics but also, very probably, false.

Let's consider a few more things wrong with this liberal response:

--The alleged rationale for a socialized medical system is that medical care is so important that it can't be left to the market, lest people fall through the cracks and not get what they desperately need. Leaving aside the very serious economic problems with this claim, if feeding and hydrating your patients while they are in the care of the socialized system isn't on the list of provided services, what's the point? Why take on a patient at all if you don't intend even to provide him with the most basic and therefore desperately needed care? Any system that is providing some people with IVF treatments (which the NHS does) but dehydrating other patients to death has a major problem of priorities and has no standing to bill itself as compassionate or as meeting fundamental needs. It would be better not to take responsibility for a patient in the first place (which is getting around to the title of this post) than to take responsibility for him and then deny him the bare necessities of life when he is at his most vulnerable. Food and water are not outlandish treatments but basic care. No medical system can have credibility qua medical system if it is dehydrating its patients to death, because such a system is simply not caring for its patients, period.

--Feeding and hydrating patients is not extravagantly expensive in itself. I strongly suspect from the sheer scale of the use of the Liverpool Care Pathway that a large number of the patients being killed in the NHS actually could eat by mouth. (Compare Pastor Joshua's case in Canada.) So there we are simply talking about feeding by spoon, giving fluids, etc., in a natural way. An NG tube, if needed, is very low-tech and hardly a large expense. And even if something like a PEG tube needs to be put in place, this is relatively minor surgery and can even be maintained by family members after the fact. Actually, tube feeding can provide a monetary savings over feeding by mouth, because it is less labor intensive and more efficient for nourishing and hydrating the patient, especially when the patient is an adult or older child and requires fairly large quantities of food. The repeated implication that feeding and hydrating disabled and/or dying patients is some sort of vast expense is simply bogus.

--A related point is that what is expensive, especially in a patient that is comatose long-term, or in an elderly patient who will live for some years more, is not the feeding and hydration itself but simply the general nursing care, continued over a long term, of the patient. In other words, it isn't that getting food and water to the patient is expensive in itself. It's that it costs money to continue (darn it) caring for the patient at all if he doesn't have the decency to die. It's the life of a disabled person who cannot care for himself that costs a lot in terms of daily care. But once we admit this, then what we have to admit is that patients are being dehydrated to death not because getting them the bare necessities of life is in itself extraordinary care, excessive, "keeping them alive on machines," or anything of the kind, but because the system doesn't want to keep caring for them at all. In other words, it then becomes evident that the very intent of withdrawing the food and water is that the patient should die, because disabled people take a lot of care! But in that case, the references to money and expense, which give the specious impression that families who don't want their loved ones dehydrated to death are asking for something intrinsically unreasonable, are a smokescreen. What is really being treated as unreasonable is that the families don't want their loved ones bumped off! And what is being suggested is that they should be required to pay through the nose to ransom the lives of their loved ones, who in a "rational" system would be purged out of the system because their very existence and need for basic care are a drain on the rest of us. Once one realizes that, one should laugh in the face of anyone promulgating this approach while characterizing conservatives as heartless.

--While part of the motive for dehydrating patients to death is system-wide cost savings, it does not follow that patients or their families are given any other option "if they can pay." In fact, the up-front rationale for dehydrating patients to death is what Wesley J. Smith calls "futile care theory." Futile care theory holds that if a patient is not expected to recover to the point that his life is considered worthy of life by the technocratic ethicists, then it is not rational to continue giving him what he needs to live. The sooner he dies, the better. Of course, this is all wrapped up in vague talk of "medical futility," but that's what it comes down to. Given that this is the case, this up-front rationale is not going to be withdrawn simply because a wealthy family member is willing to pay for the "extra" expense of feeding his loved one. The claim, in fact, is that it is wrong to continue feeding and hydrating the patient, that it is against medical ethics, that it is medically and morally inappropriate. That is how it is presented to patients and families. That is what the medical profession tells itself. That is, in fact, precisely how the medical profession avoids the cold-hearted sound of saying, "We want you to die now, because we just don't want to be bothered with you anymore." Instead, an elaborate medical ethics rationalization has been developed, and, believe me, that rationalization has a life of its own. That explains the fact that Zach McDaniels in the U.S. was nearly dehydrated to death on the basis of a "medical futility" judgement by a hospital death panel, despite his family's ability to pay through insurance for his continued care. This explains the judgement in the UK, in response to Leslie Burke's attempt to gain reassurance that he would not be dehydrated to death later against his will, that doctors should be able to cut off food and water to patients even against the patient's wishes.

When a patient is on a pathway to death, this is all orchestrated very carefully within a medical ethics framework that is meant to allow everyone to accept what is being done. It is not a matter of saying, "Oops, sorry, you ran out of money, now we can't help you anymore. You're on your own. Do what you want." On the contrary, even when infants are sent home to be killed by dehydration, it is still orchestrated, to make sure the infants do not get hydrated! These patients are being carefully and deliberately ushered out of this world because that is allegedly the "way it is supposed to be."

--The UK has a history of insisting on keeping minor patients against parents' and families' wishes when the intent is that the patient should die. This is the ultimate logical conclusion of the insistence that this is about what is medically appropriate rather than being (up front) about money. See, even if it costs us more money, we will keep your children and make sure that they die when we think that is what is supposed to happen according to our utilitarian calculus. This was the case in the David Glass case (though he was actually saved from the system by courageous relatives) and in the infamous Attard Siamese Twin case in 2000. The latter is especially noteworthy, as the parents, once they realized that the doctors wished to kill one of their children to save the other, simply wanted to be allowed to take their babies and go away in peace. Instead, the British system deliberately kept the twins, by court order, in order to carry out a costly surgery that killed one twin to save the other.

All of this brings me, finally, to the intentionally startling title of this post: In a number of ways it would be better if some patients were simply abandoned by the official medical system and discharged (without npo orders, needles to say) to their family or to nuns or other do-gooders (and I mean that phrase in an entirely non-pejorative sense), so that they could be taken care of as best as possible on a shoestring, rather than being kept as patients by the allegedly "civilized" medical system. This is because the "civilized" medical system will insist on bringing about their deaths by the deliberate, careful, and prolonged refusal of all food and water. This is especially true of patients that can eat, even small quantities, by mouth. To be sure, if all that an older or larger patient can eat and drink are small quantities, it will be impossible to keep him alive like this indefinitely. Sometimes a long-term PEG tube is inserted for this very reason, when a patient can indeed eat by mouth, but spoon feeding is so slow and inefficient that the patient will not be adequately hydrated and fed by this means over the long term. Nonetheless, at least the person will not simply dry up and die in ten days, and in the meanwhile the patient will be receiving the kindness of gentle attempted feeding which will also alleviate the discomfort of thirst.

Moreover, the medical system is heavily drugging these patients, sometimes to the point of sedating them, which makes them unable to eat by mouth. If they were discharged to be cared for as best as they could be in a low-tech fashion, this medicalizing of death need not occur, and there would be no presumption for heavy drugging or sedation. That would give them a better chance to eat and drink. Some might even survive much longer than expected by the all-wise doctors, or even recover, if only they received care rather than being deliberately killed by "nothing by mouth" orders plus major drugs. And those that did die could be treated more humanely in the meanwhile.

Having the medical establishment let go of the patients rather than keep them and kill them would also help to avoid the corruption of nurses, doctors, and family members by teaching them that it is okay to dehydrate people to death and by forcing them to steel themselves to go through this traumatic, lengthy, and gruesome process.

Finally, simply discharging the patients to the care of those who will take them would strip away the pretense of care that the medical system currently retains. By keeping control over the patient until he dies and carrying out medical acts like drugging the patient, the medical system retains a corpse-like caricature of professionalism: "See, we're not abandoning our patients. We're taking care of them." When, in fact, they're "caring for" them to death. By saying outright and more honestly, "We refuse to care for this patient anymore. You care for him, or find someone who will, as best you can. We disclaim all further responsibility," the medical practitioners of England, and the bureaucracy that controls them, takes off the mask. And by their doing so, the patient is given at least the possibility of living and being cared for better.

A possible rider to this suggestion would be that the hospitals agree, for patients expected to survive long-term if given basic care, to put a PEG tube in place and to teach family members to care for it and to use it to administer food and fluids. Since the patient will be "off their hands" after that, this relatively small final treatment could hardly be called an extravagance.

Lest I be misunderstood, I don't think that patients in the UK should have these as their only options--be dehydrated to death or be sent away--but if "caring" is going to mean killing by prolonged dehydration, being sent away instead to be cared for by someone else, even someone without medical credentials, begins to sound better and better. It at least ought to be offered as an explicit option.

Ideally, religious orders and groups could step forward, as Mother Teresa offered to "take" any child whom the mother wanted to abort: "If you don't want these patients, these disabled and elderly people, these newborn babies, we do. Let us care for them if you won't." Or the orders or religious charities could support families who wish to care for the person at home. All with the explicit promise, "We never dehydrate anyone to death. We are here to help you and your loved ones to avoid that fate."

Now, I hardly expect that this idea of mine will be seized upon eagerly either by the British or by anyone else. But if not, why not? Why, also, will a liberal such as the one described at the beginning of this post balk at such a suggestion? After all, he's the one suddenly getting all cost-conscious. He's the one getting smug and trying to play a gotcha game with the pro-lifer who also thinks socialized medicine a bad idea. Why oppose this idea?

What my proposal essentially says is this: If this medical system is so morally corrupt that it insists on killing its patients, then let my people go. Give them to those who will love them and care for them as best they can instead of killing them. Give others a chance, at virtually no cost to the "system." If you simply want our children, our elderly, our loved ones dead, then we aren't going to let you control their care anymore. Give the families an explicit option to take them elsewhere or take them home and feed them. And do that instead of arm-twisting the families to get them to agree to the deliberate, medicalized killing of the vulnerable. And if you won't, then shut the heck up about expense. Because it will be absolutely clear at that point that it's all a lie.

That is my case for "throwing patients out in the street." If that's the kind of hospital you're running, do the patients a favor: Throw them out.

Comments (43)

These posts regarding end-of-life care (even when it can't really be called "care") are interesting to me.

When reading this post, Lydia, I couldn't help but think of my mom. She died this last September at the age of 66 after being diagnosed with end-stage acute myeloid leukemia. I am in the USA and so was she, though not in the same state.

She was sick for a couple months and wasn't getting better, so she went to the hospital. During the routine range-finding tests they found anomalies in her blood work that prompted more specific tests, and so on. The diagnosis of AML wasn't long in coming and the evidence indicating that her marrow was all but gone was fairly conclusive as determined by me, my family (some of which are medical professionals), my mom, and the doctors. She decided not to try chemo since after 60, the recovery rate is very poor and there was a good chance, given the state of her immune system and anemia, that it would kill her outright.

The AML caused hemorrhages, kidney problems, etc but they were able to help her through that by giving her massive, regular blood transfusions and platelet packs. When the transfusions weren't regular, she dipped downhill quick.

It was clear that to keep her alive, though one couldn't exactly say "healthy", would mean the continuation of daily or twice daily transfusions of blood and/or platelets. Rather than insist on this or on chemotherapy, she decided to go home, try homeopathic remedies, and see what happened. We didn't stop her or try to talk her out of it and no one pressured her to choose this. I know there was no pressure because family was with her in the hospital 24/7 and because she talked about issues like this many times before she got sick and said what she would choose. My sisters (some of which are nurses) cared for her round the clock for the few days she lived at home. She eventually succumbed, though we could have kept her around indefinitely with the transfusions.

I'm sure you can see what my question will be: What do you think of what happened, given what you've written here and previously? Are transfusions equivalent on some level with food and water? Should she not have chosen to forego them? Should we have insisted that she continue to have them? Is a person diagnosed with end-stage AML equivalent to a "disabled" child or "ill and elderly" adult?

She could have been kept alive indefinitely. We had the technology, we had the resources (at least for now).

I know it's a bit loaded, but I am genuinely interested in reading how you think of this since it seems to parallel (on some level) what you are writing about here.

No, I don't think that transfusions are equivalent to food and water. I think that food and water are self-evidently ordinary care. They are, as it were, rock bottom. *Everyone* dies without them. They should not be regarded as medical treatment at all.

Now, it doesn't follow that there are no circumstances where it is ethically imperative to give blood transfusions. We can imagine a situation where a person has suffered an injury with blood loss and is brought into an ER needing a transfusion. The doctor has the blood and everything but prefers to sit around smoking a cigarette and having a nap rather than give the transfusion (just to make up a scenario). So the patient dies. This is obviously negligent and wrong. The doctor isn't treating the patient *as* a patient.

But what we start with is the recognition that some things are treatments and other things are ordinary care. That should inform our future conclusions. There are times when it is wrong, negligent, etc., not to give some treatment. But it still remains a treatment, and there may still be situations, as in the case of a dying patient, when that particular treatment can be foregone.

I would note a difference, too: Giving antibiotics is also a treatment. However, suppose that your mother had lived longer and developed pneumonia (or a UTI or something like that). I think it would probably have been negligent deliberately not to give her antibiotics for pneumonia.

It's interesting that you bring up antibiotics because another complicating factor was a systemic infection which she was treated for, and which was eliminated, after the diagnosis of AML. Clearly, the doctors agreed with your position.

So, in your view, the choice she made, and that we abetted, was morally clear?

I'm not looking for your personal absolution, rather I am looking for a clear statement on a case like this, which seems to fall under "futile care". Is "futile care" a valid category and if so, how do we delineate it?

I agree with your comments so far vis a vis denying persons of whatever age food and water, especially when they are capable of consuming them naturally. Thus, I'm not coming at this from a devil's advocate/troll standpoint. We didn't deny my mom food and water. She was sipping water, literally, up to the point that she stopped breathing.

I know I'm putting you on the spot, but this is something that I have been turning over in my head since everything happened and you are writing on the issue.

No, I don't think it falls under "futile care" at all, and I think it's important to realize that "futile care theory" is a whole theory. It's very totalizing. You would probably find it useful and interesting to read a lot of what Wesley J. Smith has written on the whole idea of futile care theory. And to be clear: Smith usually says (though I believe rather reluctantly) that patients should be allowed to refuse even lifesaving care themselves, including nutrition and hydration. But he usually adds that it needs to be an informed choice and that most patients aren't adequately informed about it. The latter point is quite true. If you tell people they will dry up and die over an agonizing thirteen days or whatever, they usually won't believe you.

Anyway, getting back to futile care theory: The blood transfusions would, in fact, have worked for their purpose in your mother's case. Therefore they were not futile. The marketing for futile care theory is generally done by a classic bait and switch. People are given the impression that "futile" means "will not work for its purpose," but what is really meant is "will not work to make the patient recover." There is, of course, a major difference between the two! I think the whole "futile care" thing is a morass that we needn't get involved in at all.

My own opinion is that your mother's course of action was quite morally legitimate.

However, I want to make something clear: Because of the urgency of fighting the futilitarians on the matter of nutrition and hydration (including by a feeding tube, which is still quite a low-tech matter and not extraordinary care), I generally think it's far _more_ important to have that clear, bright line between ordinary care and medical treatment than to have a definite answer on every possible scenario concerning when actual medical treatment is morally required. The trouble with discussing the latter a great deal is that we get ourselves bogged down and come to think that "this is all just too complicated." Then we are vulnerable to being bamboozled concerning nutrition and hydration, because the current medico-legal consensus is becoming increasingly anti- on nutrition and hydration for dying patients and increasingly inclined to order it stopped. The phenomenon of getting bogged down is rather like what can happen to a college freshman who takes his first ethics class. The prof. throws all of these scenarios at them, which (even if unintentionally) creates the impression that moral dilemmas are all around us, which in turn makes it harder and harder for the student to recognize moral absolutes.

To clarify: I think that patients should always be given nutrition and hydration. I don't think we should have created this "right to refuse nutrition and hydration" in law. That is one point where I differ with Smith.

I think I understand your position, as far as I am currently able. I will look into this W. J. Smith's writings and see what he has to say.

I also understand that you don't want to get too mired in specific test cases, so I won't belabor your good will much more. However, it seems that some specifics should investigated, as you have done countless times. In the case of my mom (and we, the co-conspirators), whom I think made the right choice, is a good place to mark a boundary.

If futile care is defined as you say, "a treatment that will not accomplish it's purpose", then that gets sticky. A rather Aristotelian mode of speaking! Which purpose are we speaking of? The purpose of completely curing the person? Of making them more comfortable while they expire of a disease we can't currently cure or treat? Protecting the lives of persons able to live, though perhaps in some "diminished capacity" (Downs kids, etc)?

Clearly, the transfusions accomplished the purpose of improving her blood biology and biochemistry, returning her body to a more "near normal" function... Until she needs another transfusion. However, they would not accomplish the purpose of curing the AML, nor could they, even in theory get her to a state where she could safely undergo chemo. Thus, there is clearly a purpose that cannot be attained with the transfusion therapy.

This seems like an issue worth knowing something about, so I'll see what info in Smith's writings would apply here. I would be pleased to receive a recommended starting point.

For the record, I also agree that there should be no right codified for doctors to refuse nutrition and hydration. I also agree that it will naturally follow from our current culture combined with a federal single-payer system.

I really don't see how there's anything very tricky about figuring out the purpose of a treatment, nor why a statement's being "Aristotelian" is supposed to be a mark against it. Treatments always have some stated purpose, or rather, some range of likely outcomes, and those purposes vary from one treatment regimen to the next. They also vary in particulars such as whether it requires serial application or not. The fact that some treatments are intended as cures and some merely as ameliorative doesn't seem like a very bedeviling factor, either. Not every treatment has as its end a full and final cure, and many treatments are approached with a range of possible outcomes in mind--a liver transplant may extend a person's life, or it may cure him altogether, but if it can be known in advance that it will achieve neither of these ends, then it is futile. If it stands some reasonable likelihood of achieving either one, it isn't futile.

The fact that it would be futile for the far less realistic purpose of making the patient into a Pro-Bowl selection at middle linebacker seems pretty much irrelevant, and not a problem whatsoever from an ethical standpoint.

Aristotelian isn't a mark against it, but rather an observation that persons who would otherwise eschew such thinking about purposes about human life (the proponents of death) might employ purpose-language in another context.

Mr. Fosi, I was the one using purpose language and, yes, I was applying it to the immediate purpose of improving blood biochemistry. Now, there is a sort of diminishing returns problem in such situations where the transfusions work for shorter and shorter periods of time until it would be fair to say that they are not working even for that limited purpose. As you presented the situation, that was not the way it was at the time that your mother refused them, which was why I said that I did not think it would be accurate to call them futile. But that does not in itself mean that it is wrong to reject a treatment. For example, a person is not wrong to reject a kidney transplant even if there is a good reason to believe that the kidney transplant would be successful on its own limited terms concerning the person's having a functioning kidney.

I would suggest if you want to read what Smith has written about futile care theory that you do a Google site search at his blog location with his archives using the phrase "futile care theory." The current site location is

Futile care theory holds that if a patient is not expected to recover to the point that his life is considered worthy of life by the technocratic ethicists, then it is not rational to continue giving him what he needs to live.

It should be called "futile life theory" since that's what it really is. And that is why it is wrong. There is dying and there are futile treatments, but there are no futile lives. Accepting death when it comes does not entail rejecting life.

To clarify: I think that patients should always be given nutrition and hydration. I don't think we should have created this "right to refuse nutrition and hydration" in law. That is one point where I differ with Smith.

Lydia I'm not sure I understand now that you've said this. I agree that whatever we permit people to do, there is no "right to refuse nutrition" per se. My understanding is that even basic care (and I agree that ANH is basic care) isn't obligatory if it isn't considered beneficial on a right understanding. I think analogy is the way to go here. If a person is really dying the body at some point begins shutting down and can't use the food. The analogy is that we don't force-feed the dying. We feed them right unless and until the point is reached where doing so no longer provides a benefit to them, and indeed may be harmful and irritating. I thought that was your understanding until this last bit so I'm just asking.

Any treatment, whether basic or not, that no longer provides a benefit is considered futile. The problem is that the futilitarians say there is no benefit unless your "quality of life" is thus and such, and the self-serving criteria used doesn't accord with the patient's good, but rather the selfish "good" of persons who want them gone.

I generally think it's far _more_ important to have that clear, bright line between ordinary care and medical treatment than to have a definite answer on every possible scenario concerning when actual medical treatment is morally required.

I agree. I think Gilbert Meilaender used the example of turning patients in their beds that can't do so themselves to illustrate basic care. Isn't that basic care? I think so. Does it matter if they are dying? I don't see how.

As Lydia is saying, making distinctions is the most important thing. For example, there are multiple reasons for eating. We do it in part to nourish our bodies, and partly for pleasure, comfort or pain avoidance to put it negatively. All these things should be considerations in deciding whether food is a benefit to a patient that is dying. The fact that we have to make the decision for someone else, and reasonable people may disagree on some points doesn't change the fact that that should be our criterion.

Another critical distinction I think is the one between food and water. We tend to conflate them when tubes are used because they deliver both. But we all know that thirst and hunger are quite different, and the need for water is more basic and immediate even than food. The article linked from The Daily Mail above shows this. Christ himself said "I thirst" when he was dying, and I think there is reason to think it is common for those who know they are dying to desire water. It seems to me we don't have examples of the dying saying "we'll, I'm dying so don't bother with the water." If not, how dare we make that judgement for others?

A couple other points about the Daily Mail article. It is just insidious how the futilitarians use people's emotions. The anonymous doctor says "They wish for their child to die quickly once the feeding and fluids are stopped." As Gilbert Meilaender has said, it isn't sinful to hope or pray for the death of a loved one who is dying. No one wishes for a long protracted death. But the problem is that unless we're going to put people down like animals that we don't actually have the power to guarantee a quick death and hoping for it by way of not planning for anything else more often than not results in a far worse death even if it couldn't have been avoided. It is an idealism that is pitiless in fact. Just horrifying. As he says, ‘It is a huge supposition to think they do not feel hunger or thirst.’

An NG tube, if needed, is very low-tech and hardly a large expense. . . . The repeated implication that feeding and hydrating disabled and/or dying patients is some sort of vast expense is simply bogus.

Yes, but here is where socialized medicine has a say in the matter. There are true costs, and there is funny money. Our insane regulatory environment where the the men and women providing excellent trauma care for our soldiers couldn't get a job in the medical field because they aren't properly licensed makes it so the cost appears to be anything the regulators want it to be. So if they say the cost is very high for feeding tubes, and they control who can do it, then who can say different? This is how insidious the whole medical regulatory establishment has become. Ike's scary warnings about the "military-industrial complex" is whatever is the opposite of prescient.

One last thing. I have had exactly the same thoughts as Lydia for some time about how the church could provide alternatives to all this. There are regulatory hurdles, but they could and should be allowances for this. And I suspect there are further benefits that would be realized as well. Those going in would have to know the limits of a low-tech care facility, but the tradeoff of a more benevolent and faithful system I suspect has more positive benefits than we think.

I increasingly think our bureaucratic medical system is a danger to us all. Even the healthy aren't safe from it if they go in without a good bit of skepticism. We vastly overestimate the positive benefits of modern medical care. What it does well are the mechanical things like putting together broken bodies and microsurgery. Other than antibiotics and painkillers, most of the medications do little good in my opinion and do a great deal of positive harm.

A lot of comments here, Mark, and I don't have time to reply to them all right now, but I wanted to say something about your last one re. regulatory hurdles. I have no doubt at all that if the NHS were deliberately dehydrating some patient to death, they would object to discharging him into the hands of some extremely low-tech missionary hospice to just feed him by spoon and care for his basic needs like bed turning and hygiene. Especially if carried out without inspections, regulations, blah-blah.

The irony there, as I think you and I agree, is shouting. What it amounts to is, "It's more important that we should *make sure you die* in a professional environment that is in some sense 'regulated' than that you be actually cared for in a less professional environment that is unregulated."

If "regulations" don't insure that patients are not deliberately dehydrated to death--and let us make no mistake, that is what we are talking about here, the food and fluids are to be withdrawn *until the patient dies*--what good are they? There is something positively chilling about the fussy horror of the modern liberal over unregulated environments when the regulated environments are, literally, murderous.

And mark my words: It's only a matter of "when" not "if" this moves to direct lethal injection, the same will apply. "Tomorrow we're going to give your baby a lethal injection. Say goodbye today. No, we won't let someone else take care of him in a house somewhere. He's a sick child. They don't have the professional qualifications and haven't had their facility inspected."

Mark, to answer your question on people who "refuse" food and water. It of course doesn't follow from the fact that someone is refusing food and water that his body is unable to assimilate it. There are numerous anecdotes of people who have done so as a form of suicide (though people are reluctant to use that word). It seems to me incredibly ironic that our modern medico-legal establishment increasingly has no problem with drugging people into insensibility so as to *withhold* food and water without protest from the patient but does not, in such suicidal cases, think it would be right to sedate someone in order to *administer* food and water.

Are there *real* cases where a person's body is literally unable to assimilate nutrition and hydration, for strict medical reasons? Yes, I believe that there are. However, it's a little bit like the boy who cried wolf. At this point, our medical establishment is not a reliable indicator of when such cases arise, and any such claim needs to be viewed with great suspicion, especially if it comes with the order that nothing whatsoever, even small sips of water or ice chips (which should do little or no harm even if the body is not processing properly), should be given by mouth.

Dehydrating stroke patients is a case for particular suspicion. If the person's swallowing mechanism might be compromised, he may be kept in extreme discomfort from thirst, restrained from getting out of his bed to seek water, and so forth, simply because the doctors and family have decided not to insert a feeding tube. This does *not* mean that the body is not able to assimilate nutrition and hydration. A possible complication is that of the heart patient who has had a stroke. For some reason, NG tubes are considered taboo in these circumstances, perhaps because of alleged throat problems caused by the stroke. Yet if the person is a heart patient the doctors will suddenly act as though even the small amount of anesthesia for implanting a PEG tube "might be fatal" and will then dehydrate the person to death (which is *certainly* fatal) instead! The hypocrisy here is sickening.

Another anecdote: There was a case some years ago where a woman in Europe had been diagnosed as being in a PVS. Eventually her guardian ad litem decided to have her nutrition and hydration (which appeared to be working just fine, thanks, to keep her alive) withdrawn. When there were objections from pro-lifers, the guardian ad litem suddenly started claiming that the food and water "wasn't being properly processed" and based this on the allegation that her condition was going downhill. Of course, it didn't follow from the fact, if it was a fact, that her general condition was deteriorating that she wasn't processing food and water. After the food and water were withdrawn, she died over the standard 10 day period for being dehydrated to death. All these facts suggest strongly to me that the claim that she "wasn't processing" the food and water was false.

So it is to the point where I would reflexively distrust any claim that a person "could not process" food and water. I would want to know excruciating details about why and how this was supposed to be the case, how the doctors claimed to know that this was the case, what harm it could possibly do to give small quantities of fluids to a dying person for the sake of comfort, and so forth.

Oh, another story: I read an interesting article in Human Life Review by a hospice worker. She told about a Catholic hospice in which a woman was dying of colon cancer. The woman had a large tumor blocking her large intestine and certainly couldn't properly process food. It was a straightforward case. She sat all day in her bed watching EWTN and praying for a miracle. They gave her food. The patient enjoyed it and hoped it was doing her some good. Then (I don't want to get too graphic here) a half hour to an hour after each meal, the hospice worker had a painless way, related to the woman's having had surgery earlier, of getting the food back out before it could cause harm or discomfort. This process went on, the patient always hopeful and an inspiration to many, until she died.

By the way, Mark, you might find this interesting: I was just reviewing some old correspondence on my hard drive. I found a letter from 2005 expressing disappointment to my local pro-life group over a column they had printed in their newsletter by a doctor and state lawmaker, allegedly pro-life. This doctor had written a column about the death of Terri Schiavo. He had a few good things to say, such as to warn about hasty or faulty diagnosis of "PVS." However, he then did this: He started talking about cases where people's bodies "cannot assimilate" food and water and where it is therefore "futile." He proceeded to say that it was "understandable" that Terri's husband might have thought her food and water were "futile" if she was merely engaging in "reflex breathing" over a period of years and would never recover. The slide was so blatant, and it was extremely shocking that it was published in a pro-life organization's newsletter.

After that, I realized even more how untrustworthy doctors are on their claim that people "cannot assimilate" food and water. He apparently thought that that had _something_ to do with not recovering cognitive function.

Socialized medicine is all about control and power. Every area in which we allow government intervention will eventually end up being fully under government control. Welfare has permanently enslaved a 'poor class' that is under the government's thumb. Social Security has made our senior citizens another 'class' with permanent tethers to government. Medicare and Medicaid were the government's further hold on these two classes, but now with Obamacare they are solidifying the government hold on all Americans. Once they buy you with a "benefit", you are enslaved for life.

After that, I realized even more how untrustworthy doctors are on their claim that people "cannot assimilate" food and water. He apparently thought that that had _something_ to do with not recovering cognitive function.

Lydia, I agree that many have the agenda we're speaking of and are untrustworthy. But I was assuming the judgement of a person with the best interests of the patient in mind properly understood. That in turn assumes a condition or disease killing the patient. End stage cancer and that sort of thing where the body is shutting down. This was the case with my father. It is my understanding, which could be wrong so I'm open to correction on this, that to continue to insert food in these circumstances actually causes harm and discomfort to the patient. At least some of these patients (my father in particular) are not unconscious though they can't open their eyes and can't express themselves, but they can clearly have an awareness of your presence and can feel pain. Now I have no trust in the diagnosis by the usual suspects of PVS because of the same agenda, so this isn't surprising to me.

And about the forced feeding issue, I think that is more problematic than you're allowing. The more likely case is when people in the late stages (at least with brain cancer) would have to be restrained to keep feeding tubes in. I do not think people who are in this state should be forced to endure it even though some are not fully of their right mind. They are very uncomfortable as can be seen from their actions, and they are dying. Gilbert Meilaender also thinks this.

Though I completely share the disdain for the "futilitarians" with you and Wesley Smith (and find the term useful), at the end of the day I think we need to be mindful that they are right that there is over-treatment that is futile and merely prolongs a painful death. And that sometimes we force it on the weak with misguided intentions. The problem is that they have a different agenda that goes way beyond this. They believe in more than futile treatment, they believe there are futile lives.

On the other extreme, oftentimes certain treatments are necessary because a prior treatment was given, or prior to that, and on and on. For example, respirators are used as often as they are frequently because they are hoping to convince the family to agree to organ-farming. Anyway, sometimes you look at the original condition and prognosis and ask yourself if their wasn't some fuzzy-headed optimism involved from the start. Was it really necessary to prove over days or weeks what typically happens? In a better world wouldn't we just treat the patient as a person and wait and see in many cases? Things become apparent in time.

In the case of my father there sure was some fuzzy headed optimism. It was no one's fault really, but the perfect storm of a service oriented medical establishment that doesn't want to admit defeat and the family in the dark about the likelihood of a typical result that no treatment could help. The result is only a prolonged, more painful, and fearful death than otherwise. If we can't acknowledge at least this much common ground with the futilitarians, we'll never be able to refute the rest of their evil ways.

I also don't see anything wrong with sedating patients who are dying and likely in pain. The intent is not to hasten their death, but to alleviate their pain. If it does hasten their death it is a classic case of PDE (principle of double-effect), and thus permissible. Sorry if I rambled a bit.

But I was assuming the judgement of a person with the best interests of the patient in mind properly understood.

I was thinking of something more sweeping--pervasive fuddle-headedness, the medical equivalent of "urban myths," leading to unreliability even among well-intentioned medical people who want to do what is right and have the best interests of the person at heart. Nurses who will say *in general* that dehydration is "always a natural part of the dying process," because presumably someone taught them that. And so forth.

It is my understanding, which could be wrong so I'm open to correction on this, that to continue to insert food in these circumstances actually causes harm and discomfort to the patient.

Were I in the situation, I wouldn't take anyone else's word for that or take it as a general rule. I'd be looking for specific evidence. And as you said, the distinction between food and hydration is a very important one as well. If a doctor tells me in sweeping terms that it's going to cause "harm and discomfort" to give a loved one sips of water, I'm going to hae me doots, especially if I'm not getting any such signal from the loved one.

Then, too, let's remember that IV hydration is another tool that can help keep the person generally hydrated, though my impression is that some water by mouth will still be necessary to prevent discomfort from thirst.

About your comment about "patients who are dying and likely in pain." I think we need to be very careful about that. The medical establishment tends to assume that anyone who is dying is in pain. Why assume that? It is by no means always true. Use pain control when you actually have evidence that it is needed, and only to that extent. The medical establishment is now getting slap-happy with the morphine drips. Let's not encourage them in the tendency. Still more, sedation is a pretty heavy level and will guarantee that the person cannot receive food or fluids by mouth. That's then a real set-up for, "Oh, now what do we do? The only way he can receive food or fluids is by tube, and that would be _unnatural_," when that wouldn't have been the case had the person been less heavily drugged.

Were I in the situation, I wouldn't take anyone else's word for that or take it as a general rule. I'd be looking for specific evidence.

I'd absolutely look for specific evidence. But surely we could use the judgement of other doctors that we can trust because they have similar beliefs to ours. They must be out there. It would be valuable empirical knowledge to have.

And as you said, the distinction between food and hydration is a very important one as well. If a doctor tells me in sweeping terms that it's going to cause "harm and discomfort" to give a loved one sips of water, I'm going to hae me doots, especially if I'm not getting any such signal from the loved one.

Oh I agree. I was actually speaking only about food, and not water. I just can't see how administering water in whatever form it can be absorbed could ever be harmful or discomforting. I just can't see it and unless someone could convince me I'd never believe it.

The medical establishment tends to assume that anyone who is dying is in pain.

I have a different view. They see what they want to see, influenced by their own self-interest. A doctor wanting to diagnose the problem says "oh he's not in pain; he can't feel a thing. You see there are no nerve endings in the X". Brian cancer causing pain? What a silly idea. He needs to think that because he wants to keep poking and probing around the patient as science-experiment, and pain-killers mask the symptoms and the patient has less value if he can't accurately judge symptoms. I have only my father's case and I had doctors deny pain insistently. One said, well "maybe a slight headache". How do they know it might not be a bad migraine headache, or the worst stomach ache of all time? They don't.

Some doctors want to keep you alive, and some doctors think you're better off dead. What we need is a better understanding of how people should be treated in a low tech environment generally that doesn't accept the medical-scientific understanding of life, rather than a reactionary understanding where we do the opposite of whatever the futilitarians want. I'm not saying you're doing that, but where are the romantics when you really need them? We can learn a lot about proper treatment of patients by looking into the past when there were fewer options. Here is Paul Griffiths giving a lecture called "Defending Life by Embracing Death: Caring for Health by Recovering the Ars Moriendi" at Baylor. I think he's basically got it right.

Though I completely share the disdain for the "futilitarians" with you and Wesley Smith (and find the term useful), at the end of the day I think we need to be mindful that they are right that there is over-treatment that is futile and merely prolongs a painful death. And that sometimes we force it on the weak with misguided intentions. The problem is that they have a different agenda that goes way beyond this. They believe in more than futile treatment, they believe there are futile lives.

This gets to the heart of my uncertainty about many of these medical ethics issues, and why I'm not willing to engage them too closely in debate with other conservatives. Liberals, of course, are "right" about the existence of problems in our treatment of the terminally ill in many of the same ways they're "right" about globalization--as agents of the culture of death, it's just a case of a stopped clock being right twice a day, so they're not really worth consulting and should be resisted, but not reflexively. These problems are very complicated, and require more careful study than I've ever had time to invest. In a sense, as is the case for a lot of human affairs, they're too complicated to be left to the "experts," who in the contemporary context are usually just agents of powerful interests whose priorities have little in common either with the divine will or with the people whom they supposedly serve.

Anyway, my family soon will be facing some very difficult choices in related matters, and I'm grateful that Lydia and Mark have engaged in this good faith discussion, even if it sometimes must be contentious.

I think most people would be surprised to find out how anti- I would be for myself concerning things like chemotherapy. In fact, I would not be at all surprised if liberal trolls, upon finding that out, would try to make some sort of capital out of it. Does anyone remember when the late JPII passed away? He _did_ have an NG tube, but he died in his own apartment and did _not_ have heavy resuscitation measures and the like. The liberal trolls would frequently bring this up as some sort of weird gotcha attempt against the pro-lifers. Now, to my mind, this was absolutely done in bad faith. But it was done.

What I think savvy pro-lifers need to realize is the extent to which choices are being taken away from them and they need to decide on priorities. Example: Is it more important to you that your loved one does not receive resuscitation attempts in the hospital or that your loved one _does_ receive hydration? Why do I ask, you may wonder. Here's why: Increasingly (see the Zach McDaniels case) DNR orders are being used as blatant code for "do not hydrate." It _shouldn't_ be that way, but we need to be savvy and know that it often _is_ that way. We need to know the code. Zach was not dying. He's recovering quite well. His body wasn't shutting down. He was able to process food and water. And maybe his parents wouldn't have minded a _real_ DNR order that merely meant not to use CPR on him if his heart stopped. Or maybe they would have minded. We don't know, but what we do know is that the DNR meant that his nutrition and hydration were stopped, and this non-dying boy who had suffered a head injury would have died of sheer thirst over a 10-14 day period because of the DNR if the parents hadn't objected and if another facility had not accepted him. Now he's in physical therapy and recovering.

So if the doctor, when you're making these difficult choices, asks you, "Do you want a DNR order in so-and-so's chart?" or even puts it there without asking, you need to be smart about that if you don't want the person dehydrated. You need to question it. Similarly with taking a person off a ventilator. Anecdotally, there is reason to believe that if a family agrees to having a patient taken off a ventilator the medical establishment will take that to mean, "Remove all nutrition and hydration" as well. It _shouldn't_ be that way, but often it _is_ that way.

Increasingly, the medical establishment is trying to take away the "middle path." Probably this is a result of conceptual and legal muddle-headedness. Now that nutrition and hydration are defined as "treatment," the distinction between extraordinary and ordinary care is not simply neglected but often outright _rejected_ and _attacked_ in the training of medical people.

So pro-life people need to realize that if they want to prevent something really bad such as almost happened to Zach and such as happens to far too many people--the heavy morphine drip and the n.p.o. order, over ten days to a fortnight, until death--they need to be prepared to do some pretty aggressive advocacy and not be too quick to accept a course of action in which, you are told, merely "unnatural" or "excessive" measures will not be taken. It may not be what you think. Even the term "palliative care" needs to be regarded with suspicion, and lots of questions need to be asked.

Unfortunately, when I say this, I fear that y'all will think, "That's just Lydia, being hyper." The talk in this very thread about merely "reflexively" rejecting what the left says or merely "saying the opposite of the futilitarians" concerns me a bit, because it sounds like perhaps these warnings aren't being taken to heart. If you care that you or your loved one not die in that particular and all-too-common way, you should be "hyper" in exactly the same fashion. Not because you definitely _do_ want a ventilator or definitely _do_ want repeated CPR efforts, but because you want to avoid the removal of ordinary care as part of a package deal.

Another point: Dosing with morphine to an unnecessarily high level (unnecessary, that is, to control pain) can sometimes obscure the nature of what is going on, because if the patient dies within, say, two days after the drip is begun, he didn't actually dehydrate to death (unless he was quite dehydrated prior to that anyway). So there is little perception of the way that the medical practices totally unnecessarily hastened his death and were responsible for it in an ethically troubling way. These are in a sense the seemingly "easy cases" where the family and friends don't have time to get really troubled about the length of time during which hydration is not being given. Especially if the person is drugged and is not asking for water (as unfortunately stroke patients often try to do--and are denied). But then one has to ask just how high that morphine dose actually was. And, again--is it more important to you that your loved one not receive "unnatural" care or that your loved one not be killed with a really whacking great dose of morphine when there was no need in pain control terms?

If people were really dying in a relatively low-tech fashion like the Pope--e.g., just an NG tube if needed and no big doses of medication--we could know with more confidence that the patient simply died of the underlying disease. But to what extent are we being given that option? My guess is, pro-actively, not much. You have to demand it. And demand and demand. And hope you get it.

One more relevant point here: The whole idea of "saving" our healthcare system by "accepting death" is highly problematic both ethically and economically. I think many people who say such things would be surprised if they could really come to believe the extent to which the elderly are living as long as they do for reasons that are not related to extremely high-tech or problematic interventions. For example, better nutrition and careful management of diabetes through monitoring. Even when drugs are involved, it's difficult to see something like blood thinners to avoid stroke, much less insulin, as being on a par with, say, open heart surgery in terms of invasiveness or expense. We need to ask ourselves exactly which of these "interventions" we actually want to advocate withdrawing from the elderly so that they can "embrace death." Do we want to advocate that the elderly have a duty to stop using insulin and die sooner in a diabetic coma? That they stop taking blood thinners and have a stroke? That they not take antibiotics if they get an infection? Not be treated for bronchitis or pneumonia?

I realize that all of this might sound like I'm setting up a straw man, but actually my point is this: The "expense" of things like Medicare is in many ways not the effect of highly expensive and invasive operations at the end of life nor of people's being on ventilators for years or whatever but rather the cumulative effect of the longer lives of many different elderly people for whom, in each case, nothing really, truly extravagant or "weird" is being done. In fact, things are being done that no one would think twice about for a person of even fifty years of age, but the elderly just need a lot of them, and there are a lot of elderly, and people are living longer nowadays. There is *no way* to avoid that systemic expense without blatantly advocating that the elderly just need to die, already. Therefore, we need to find an economically better way to process systemic expense, and IMO top-down measures are the worst possible idea there.

Sage, I cannot advise you how to go about handling your family's events as parents age, but I stand by Lydia that you have a better shot at making humane and sound decisions when less of the ordinary human care (as opposed to medical care) is in the hands of professionals.

My family's experience with my mother was a great example. We built a house with an in-law suite when Mom and Dad were still in early retirement (well, Dad had 2 part-time jobs, but he thought of that as retirement), so we had daily contact with them as age brought health problems. When Mom was diagnosed with a brain tumor, she looked at aggressive treatment options and probable benefits, and simply turned them down. She chose to die at home with ordinary medical care to control pain. Her children took turns being with her (and being out of work, a couple weeks at a time) and performing all the necessary personal care that a sick invalid needs. My wife did a lot, since it is her household to run. We had hospice nurses 2 or 3 times a week to visit, examine, and modify pain medication dosages, as well as advise on how to keep Mom comfortable as the cancer grew. Mom was somewhat incoherent for the last 2 weeks, but she was able to take food for most of that time and to take sips of water until the last 2 days. The point I am making is that because she was at home, we had much more control over her daily personal care than otherwise, and we made sure that she was fed and bathed etc. I have heard that in Italy, even in hospitals family members provide a large share of this "personal care". We had to have hospice in order to get the pain meds, but once we had the definite diagnosis of a brain tumor and a doctor's referral for hospice, they never gave us any trouble (and were a huge help in explaining what to expect).

We were blessed in a number of ways that don't apply to everyone, so other people's experience will vary. There are a lot of different good ways of dealing with end-of-life situations, because there are a lot of different ways of dying. One thing we had is a lot of family members available to help share the burden, whereas some people don't have that, so they have to make different choices.

Liberals, of course, are "right" about the existence of problems in our treatment of the terminally ill in many of the same ways they're "right" about globalization--as agents of the culture of death, it's just a case of a stopped clock being right twice a day, so they're not really worth consulting and should be resisted, but not reflexively.

No, no Sage. No. I never said, nor to I think I can reasonably be interpreted to imply, that Liberals or futilitarians should be consulted. I was quite clear when I said "they are right that there is over-treatment that is futile and merely prolongs a painful death" that I wasn't talking about consulting or compromising with them. Acknowledging the truth wherever you find it is a requirement for a serious person. That is what I said, and anyone who wouldn't stand by that isn't a serious person.

"saying the opposite of the futilitarians" concerns me a bit, because it sounds like perhaps these warnings aren't being taken to heart.

Lydia, this is utter nonsense. If you can't admit that acknowledging the truth where you find it and no matter who says it is a requirement for the pursuit of truth then I don't know what to tell you. To imply that it means something other than what any reasonable person should know it means is absurd.

My father had a very difficult and painful stay in a hospital by well-meaning doctors that didn't at all act like futilitarians. All the treatments were entirely futile, and not just because of hindsight. They had little prospects for success in my opinion. They were done for understandable reasons by well-meaning people all around, but the net effect was very bad. I am haunted by it. I do not share any common ground with futilitarians except to acknowledge what I have seen and know, and I know other Christians with similar experiences who also entirely reject the futilitarian thinking.

This is the other extreme. It isn't good enough in life to miss Scylla and hi-five at only to run head-on into Charybdis. Did you listen to the Griffith lecture? I doubt it. Appeal to ridicule is a fallacy. Can you give any content to your thoughts on Griffith's view? If not why do you engage in wordplay instead?

No, no Sage. No. I never said, nor to I think I can reasonably be interpreted to imply, that Liberals or futilitarians should be consulted. I was quite clear when I said "they are right that there is over-treatment that is futile and merely prolongs a painful death" that I wasn't talking about consulting or compromising with them. Acknowledging the truth wherever you find it is a requirement for a serious person. That is what I said, and anyone who wouldn't stand by that isn't a serious person.

Mark,

I was simply reformulating what I thought your basic disposition was. I was not trying to argue with you or contradict you. Inasmuch as we both accept what I wrote, we agree. Maybe I was unclear about that--it wouldn't be the first time.

Now, that's not to say that I would embrace whatever approach is laid out in that lecture (I share Lydia's revulsion at the notion of "embracing death" as a way of solving problems with the health care system), but it is to say that there are some real problems to work out here.

Tony,

Thanks very much for describing your family's approach in detail. It sounds as though you did much the same as we are trying to do, which is to minimize the amount of ordinary care that is entrusted to a large bureaucracy, and to maximize the time and energy invested by immediate family. We also are preparing for in-home hospice care, and declining further invasive treatments--the oncologist involved in our case is a Catholic who takes her ethical charges very seriously, so that decision was not made under pressure or without explicit consideration of Church teaching. In all, we're very fortunate.

Now, that's not to say that I would embrace whatever approach is laid out in that lecture (I share Lydia's revulsion at the notion of "embracing death" as a way of solving problems with the health care system), but it is to say that there are some real problems to work out here.

Sage, what Paul Griffith proposes in that lecture is that we do for our loved ones what Tony did for his mother. I'm really surprised when people react to titles and refuse to consider content even when it is immediately available.

He does not propose embracing death as a way of solving problems with the health care system! You've inferred this from two words? That is simply false. He is giving his view of how Christians should approach death. I'm not sure if they included the questions afterward in the video part of the lecture, but I was there. A questioner asked him afterwards what Griffith thought of his own view that this way of death could also be thought of as a Christian responsibility to conserve resources for future generations. The questioner brought his own views on the matter to the lecture, because as it happens I heard him advance the same thing in private the day before. I'll never forget that when Griffith replied, the first word out of his mouth was a simple "No", followed by stating that doing so would be a very dangerous way to think because it would imply that people have some obligation to die, and there is no such obligation. It was a curt dismissal of a view this man obviously had some investment in it such that I was slightly embarrassed for him. I remember thinking "ouch".

On the two extremes, you will not find any Christian ethicist who wouldn't acknowledge that two extremes are in play here. You will find plenty of squishy futilitarian Christians of course, but the most implacable and forceful Christian (and Jewish) foes of the futilitarians all acknowledge this. Gilbert Meilaender, Robert P. George, Leon Kass, Paul Griffiths, etc.

"Ambivalence is often a good thing. It certainly is in this case. To jettison completely the view that death is a horror to be lamented and staved off, with the accompanying idea that life is a good to be embraced and delighted in, easily leads to support for suicide, assisted or not, euthanasia, the refusal of medical treatment to those who might benefit from it, and all the other end-of-life unpleasantnesses that Catholic moral theologians rightly worry about.

But to jettison the view that death is a friend to be welcomed, a friend who will greet you one day whether you like it or not, suggests blindness to life eternal and a fixation on postponing death at all costs and for as long as possible. That fixation, because of our ever-increasing capacity to keep the body alive, now often leads to tormenting the body and the person by refusing to permit death to do its work."

And here is Gilbert Meilaender in "Refusing Treatment" in "Bioethics, A Primer for Christians"

"We should neither aim at death nor continue the struggle against it when its time has come. "Allowing to die" is permitted; killing is not. Within these limits lies the sphere of our freedom."

"If we can honestly describe a possible treatment as either useless or excessively burdensome, then rejecting that treatment we can still choose life. But if the treatment itself carries no excessive burden (even though, of course, the patient's life itself may be burdensome), and if the treatment will benefit the life the patient has (even though, given alternatives, we would not desire that life), we ought to choose life both for ourselves and for others.

. . . we should seek to bring the person in our care to that moment in which he can know "the truth" of his condition–the moment of death."

I could quote Kass and the rest but you get the idea. All of these Christian ethicists loudly oppose the futilitarian view, and object vehemently to assumptions implicit in the PVS (permanent vegetative state) understanding of human states, indeed even the humanity-denying nature of the term itself. But as philosophers they are careful to note that there is another extreme to be avoided, especially with the rise of medical technology. Also, we should also be mindful that there is a long Christian tradition of thinking about death in ways that do honor to the grandeur and dignity of man and his situation in the world, but they don't necessarily accord with glib modern sensibilities.

That is a good argument for simply removing ourselves from the care of the medical establishment.

Yes. When few parents didn't see the deaths of children, and few children had both parents live to to their maturity death was a part of life, however unpleasant. Death has been medicalized and is remote to us, and family, church, and clergy has little to do with it anymore. It is remote to us. Griffiths' point, or a large part of it, was that if you don't wish to die among strangers in a hospital that way then you're going to have to opt-out of much of the "preventative care" or "early detection" schemes that are pushed so strongly. Because they imply a certain buy-in that propels you along a certain trajectory that makes no sense for those people.

I already refuse prostate exams and many other "preventative" things, especially when they pin hope on "early detection". Statistically it is bunk. Because 1) there is no evidence they actually do any good; 2) it is far too easy to be emotionally manipulated by them. I've observed this a lot in myself and my wife. They toss out off-hand remarks after examining you that are worrisome, and later you find out it is entirely inaccurate. Meantime you worry. So they give you a test they claim you need, then scare the Hell out of you with no real cause, and then make you want the validation of other tests to feel ok about your health. Then they tell your employer how much you need them by the services you've consumed at their insistence. But no test can tell you you're healthy. It's insidious. My wife and I have discussed this and it can be a hard cycle to go through, more for her than for me because women are more easily manipulated by authorities in my opinion. I've never had any respect for authority, but it has even caused me a good bit of anxiety in the past. Opting out of the worst parts of this regime in large measure is the only way for me. My own experience leads me not to trust them except for what they're good at and when it can be independently known there is something wrong.

The only prevention that works in my opinion is diet and exercise. If I have symptoms that don't go away that's one thing, but for them to generate symptoms so they can fix them? I've had enough.

Mark, I agree with you about the push for screening. I've been bullied by a physician's assistant about mammograms. In the sense that she was so angry about my not having had one that she couldn't talk about anything else during my normal yearly visit. If I'd had some other serious symptom I'd wanted to bring up and discuss with her, I would have had to interrupt her and be rude to get a word in edgewise. She was obsessed.

Oh, Lydia -- I had one who was obsessed with my getting a colonoscopy, to the point where he actually wrote all kinds of incorrect information on my chart about the problem I'd come to him to discuss; every fact I told him about my symptoms he recorded wrong. I needed to see a rheumotologist (sp?), and had to tell him all the things that were wrong on the records the first doctor sent him, which was most annoying. I found out later he'd himself just been diagnosed with colon cancer . . . so I guess that's an excuse, at least. I have, however, not been back to see him . . .

He does not propose embracing death as a way of solving problems with the health care system! You've inferred this from two words? That is simply false.

I didn't infer anything, I just stated my opposition to what it sounded as though his approach might be, if in fact that was his approach. You seem determined to have a fight, to shout "WRONG! NO!! WRONG!!!" when I'm not even interested in disagreeing with you, as I've made plain. Whatever bee is in your bonnet, get it out. Sheesh.

Yeah Lydia, I hear you. My mom's doctor told her that she had osteopenia and tried to get her to take one of those bone density enhancers (as time goes on it is increasingly clear they are problematic). She refused and it didn't sit well the the doctor. Five years later she had a doctor more to her liking and when she told him about the previous doctor's judgment he looked at her charts and said "I just don't see it". Besides which, osteopenia as a condition didn't exist until recently. I think it likely that it is simply a part of normal aging. And thin people almost always have it. Hmn. The entire condition, like many conditions now, springs from statistical analysis, much like the cholesterol phenomenon or any number of others. Any time you measure people and try to make judgements about health from those samples alone it is a sure path to unnecessary and harmful treatment. The entire approach is so very wrong. It is entirely different than finding ways to discover triggers for diseases and problems that are observed and known independently. The former way invents conditions based on empirical data.

Post a comment

Note: In order to limit duplicate comments, please submit a comment only once. A comment may take a few minutes to appear beneath the article.

Although this site does not actively hold comments for moderation, some comments are automatically held by the blog system. For best results, limit the number of links (including links in your signature line to your own website) to under 3 per comment as all comments with a large number of links will be automatically held. If
your comment is held for any reason, please be patient and an author or administrator will approve it. Do not resubmit the same
comment as subsequent submissions of the same comment will be held as well.